REGULAR ARTICLE
Relationship Between Motivation for Weight Loss and
Dieting and Binge Eating in a Representative
Population Survey
Simone Schelling, PhD1
Simone Munsch, PhD1
Andrea H. Meyer, PhD1,2
Jürgen Margraf, PhD1*
ABSTRACT
Objective: To investigate the relationship between reasons for weight loss and
previous dieting attempts and current
binge-eating episodes in overweight and
obese individuals.
Results: Number of previous diets was
significantly correlated with all three
subscales, whereas presence of bingeeating episodes was only significantly
correlated with appearance in relation
to oneself.
Method: For the n 5 355 interviewees
of a representative sample of Swiss
inhabitants (n 5 1,000) reporting a body
mass index (BMI) of 25, the Weight Loss
Motivation Questionnaire—distinguishing between the three scales health,
appearance in relation to oneself, and
appearance in relation to others—was
assessed. Pearson’s and Spearman’s rank
correlation coefficients and the partial
correlation coefficient controlling for age,
sex, socioeconomic status, and BMI were
calculated.
Discussion: Dieting and binge-eating
behavior are differently associated with
reasons for weight loss; better matching
of treatments to patients’ individual
needs might improve the high dropout
rates observed in weight loss treatments
C 2010
and enhance weight loss success. V
by Wiley Periodicals, Inc.
Introduction
Obesity represents one of the major health problems worldwide (see, e.g., World Health Organization1) and is closely associated with various chronic
physical disorders, mental disorders, and social
impairment.2–5 The majority of obese individuals
are constantly trying to lose weight by conducting
diets, that is, by consuming fewer calories or less
fat, and less frequently, by exercising more.6,7
A substantial subgroup of obese individuals additionally suffers from repeated binge-eating episodes with prevalence rates ranging from 0.7–3.3%
in community-based studies8,9 to 29.7% in weight
loss samples.10 A binge-eating episode is defined as
the experience of loss of control over eating, thus
eating a larger amount of food than others in the
Accepted 10 July 2009
*Correspondence to: Jürgen Margraf, Department of Clinical Psychology and Psychotherapy, University of Basel, Missionsstr. 60/62,
Basel CH-4055, Switzerland. E-mail: juergen.margraf@unibas.ch
1
Department of Clinical Psychology and Psychotherapy,
Institute of Psychology, University of Basel, Basel, Switzerland
2
Department of Applied Statistics in Life Sciences, Institute of
Psychology, University of Basel, Basel, Switzerland
Published online 12 January 2010 in Wiley Online Library
(wileyonlinelibrary.com). DOI: 10.1002/eat.20748
C 2010 Wiley Periodicals, Inc.
V
International Journal of Eating Disorders 44:1 39–43 2011
Keywords: obesity; weight loss; health;
appearance; binge eating; dieting
(Int J Eat Disord 2011; 44:39–43)
same time period until feeling uncomfortably
full.11 Individuals experiencing regular binge-eating
episodes are characterized as a subpopulation of
obese patients with more severe eating disorder pathology and general psychopathology.12,13 They
also show earlier start of overweight, higher weight,
more frequent weight fluctuations, and more dissatisfaction with their weight and appearance than
their obese nonbinging counterparts.13–15
Empirical evidence regarding the prognostic significance of dieting and binge-eating behavior for
treatment adherence is mixed. A higher number of
previous dieting attempts was associated with noncompletion in some studies,16,17 but with weight
loss maintenance in another study.18 Regarding
binge eating, some studies reported higher dropout
rates from weight control programs, less weight
loss, and more rapid weight regain for binge-eating
participants,17,19,20 whereas others observed equal
success of behavioral weight loss treatments in
both obese binge-eating and nonbinging
patients.21 Overall, dropout rates of up to 80% are
an important problem in weight loss treatments, as
they substantially diminish the long-term efficacy
of available treatment options.14,22,23
The practical guidelines of the National Heart,
Lung, and Blood Institute24 suggest that reasons for
39
SCHELLING ET AL.
entering a weight loss treatment represent important characteristics of patients and should be
assessed before treatment start, as they are likely to
influence patients’ attrition rates and treatment
success. Data from weight loss intervention studies
indicate that the perception of obesity as a health
risk and dissatisfaction with one’s own appearance
represent the two main pretreatment reasons for
weight loss in overweight and obese binging and
nonbinging patients.25–28 Nevertheless, their
impact on sustaining efforts for weight loss has not
yet been investigated.
Because of a lack of valid instruments for assessing these reasons for weight loss, we developed the
Weight Loss Motivation Questionnaire (WLM-Q) in
a previous study (Schelling et al., submitted). The
WLM-Q is a valid and reliable 24-item questionnaire
assessing health and appearance as the two main
reasons for weight loss on three subscales: health,
appearance in relation to others, and appearance in
relation to oneself. In this study, we investigated
how motivation for weight loss as assessed by the
three subscales of the WLM-Q is associated with the
frequency of previous diets and the presence of regular binge-eating episodes, two commonly seen
behaviors in the overweight and obese, which both
seem to influence treatment outcomes.
health risks’’). The second scale, appearance in relation
to others, deals with items focusing on the expectation
that interpersonal relationships will improve following
weight loss (e.g., ‘‘I want to lose weight to have more
friends’’). The third scale, appearance in relation to oneself, refers to obese individuals’ wishes to be more
attractive and thus to lower feelings and cognitions of
body dissatisfaction (e.g., ‘‘I want to lose weight to be
able to dress more fashionably’’). All items had to be
answered on a four-point Likert scale with values of 1,
absolutely not; 2, somewhat; 3, moderately; and 4,
strongly indicating how much participants identified
with the different statements. Multigroup analyses
between sex (male vs. female), age (\50 vs. 50 years),
and BMI (\30 vs. 30) subgroups revealed factorial
invariance for factor loadings between all subgroups
and factorial invariance for factor variances and covariances between age and BMI groups but not between
males and females: Covariances were particularly high
between the second and third scale for males (r 5 .81)
and between the first and third scale for women (r 5
.72; Schelling et al., submitted).
Dieting and Binge-Eating Episodes. Number of previous diets was assessed by asking participants how many
times they had gone on a diet in their life. Presence of
binge-eating episodes (yes/no) was assessed according
to the criteria of the Diagnostic and Statistical Manual of
Mental Disorders (DSM-IV-TR),11 where binge eating is
described as eating a larger amount of food than normal
in a short time in association with the feeling of loss of
control over eating.
Method
Statistical Analysis
Participants
In January 2004, a professional research institute in
Switzerland (GfK Switzerland) conducted a telephone
survey of a representative sample of 1,000 residents from
the German- and French-speaking regions of Switzerland. Participants were selected according to the random-quota method, with age, sex, geographical region,
and size of community being the quota characteristics.
Participants were selected from the database of current
landline telephone accounts and had to be between 15
and 74 years of age. For our analysis, we used the 355
(36%) interviewees reporting a body mass index (BMI) of
25 or above.
Measures
Weight Loss Motivation Questionnaire. The WLM-Q is
a reliable and internally consistent 24-item questionnaire
assessing different aspects of motivation for weight loss
on three scales with higher scale scores indicating higher
motivation for weight loss (Schelling et al., submitted).
The first scale, health, reflects the desire to live healthier
and longer (e.g., ‘‘I want to lose weight to decrease my
40
The relationship between the three scales of the
WLM-Q (health, appearance in relation to others, and
appearance in relation to oneself), binge-eating episodes, and number of previous diets was analyzed by
computing Pearson’s correlation coefficient, Spearman’s
rank correlation coefficient, and the partial correlation
coefficient controlling for age, sex, socioeconomic status
(SES), and BMI. The three scales of the WLM-Q were all
log-transformed to better meet the normality assumption. Ten cases being univariate or multivariate outliers,
25 cases containing at least one missing answer, and 18
cases answering all questions with either 1 (absolutely
not) or 4 (strongly) were omitted from the analysis.
Thus, the sample size used for subsequent analyses was
302. All analyses were done using the software package
SPSS 13.29
Results
The 302 overweight and obese interviewees had a
mean age of 47.1 years (SD5 14.5) and 65.2% were
International Journal of Eating Disorders 44:1 39–43 2011
MOTIVATION FOR WEIGHT LOSS
male. SES was low in 32.4%, middle in 53.1%, and
high in 14.5% of the participants and their average
BMI was 28.2 (SD 5 2.8), range 25.0–48.2. Altogether, 89 participants (30.1%) reported a mean
number of 2.7 (SD 5 1.9) previous diets, and 207
(69.9%) reported no previous dieting attempts. A
total of 11% (n 5 32) reported currently experiencing eating binges accompagnied by a feeling of loss
of control. Frequency of eating binges was below
twice per week in 55% (n 5 17), equal to twice per
week in 30% (n 5 10), and above twice per week in
12% (n 5 4) of participants. Number of diets and
number of binge-eating episodes were significantly
correlated (r 5 .17, p \ .01), although the correlation was only small to medium according to
Cohen.30 Mean values of the log-transformed scale
scores of the WLM-Q were 0.78 (SD 5 0.32) for
health, 0.23 (SD 5 0.30) for appearance in relation
to others, and 0.57 (SD 5 .40) for appearance in
relation to oneself (the theoretical minima and
maxima for all three scales were 0 and 1.39,
respectively).
The number of previous diets was significantly
correlated with all three reasons for weight loss
with highest values for appearance in relation to
oneself and lowest values for appearance in relation to others. Binge-eating behavior was only
significantly correlated with appearance in relation to oneself (Table 1). The similar values
obtained for partial correlation coefficients relative to the other two coefficients show that,
controlling for age, sex, SES, and BMI, these variables had very little impact on the relationships
tested.
Discussion
In this study, we tested the relationship between
personal reasons for weight loss as assessed by the
scales of the WLM-Q (health, appearance in relation to others, and in relation to oneself), and dieting and binge-eating behavior in a representative
sample of overweight and obese individuals in
Switzerland. We thereby aimed at gathering knowledge about possible correlates of personal reasons
for weight loss that may help to improve treatment
strategies and to reduce the dropout rates of up to
80% that are an important problem in weight loss
treatments.14,22,23
Results show that a higher number of previous
diets was associated with higher motivation for
weight loss on all three subscales of the WLM-Q.
Thus, previous dieting seems to be an indicator for
International Journal of Eating Disorders 44:1 39–43 2011
TABLE 1. Correlation between reasons for weight loss
and dieting and binge-eating episodes
Reason for Weight Loss
Number of diets
Binge-eating episodes
(0 5 no, 1 5 yes)
rp
rs
pr
rp
rs
pr
Health
Appearance
in Relation
to Others
Appearance
in Relation
to Oneself
.199**
.159**
.154*
.084
.073
.099
.151*
.130*
.143*
.112
.091
.097
.291**
.235**
.272**
.179**
.175**
.157**
Notes: rp, Pearson correlation coefficient. For binge-eating episodes this
is equivalent to the point-biserial correlation coefficient; rs, Spearman’s
rank correlation coefficient; pr, Partial correlation coefficient controlling
for age, sex, SES, and BMI.
* p \ .05.
** p \ .01.
high motivation for weight loss but probably is not
specific to any single factor, at least with respect to
the three scales that we used in this study. Nevertheless, number of dieting attempts negatively predicted treatment outcome and adherence in other
studies.16,17 It might thus be hypothesized that frequent dieting behavior is a sign of desperate efforts
to lose weight that can easily be frustrated if weight
loss expectations are not met in the short term.31
To reduce these dropouts, establishing realistic
weight loss goals and continuous monitoring of
weight loss motivation during treatment might be
important.
Regarding binge-eating episodes, a positive association with the appearance in relation to oneself
subscale was observed. This finding extends the
research of Putterman and Linden,32 who observed
that normal-weight individuals dieting for appearance reasons scored higher in disinhibition and
body dissatisfaction than those dieting for health
reasons. Moreover, research comparing obese individuals with and without binge-eating disorder
revealed more dissatisfaction with weight and
appearance for binge-eating patients compared to
their obese nonbinging counterparts.13–15 It thus
seems that individuals suffering from binge-eating
episodes are most motivated to lose weight by their
body dissatisfaction. However, overweight and
obese individuals generally only achieve and maintain weight loss of about 5–10%,24 which does not
greatly affect appearance. Thus, dropping out of
treatment due to unrealizable expectations might
become more likely.
Several limitations have to be considered when
interpreting our results. First, weight and height
were assessed by interview only, so that there might
41
SCHELLING ET AL.
be underreporting of overweight in our sample.33
Second, we did not assess binge eating based on
the gold standard clinical interview Eating Disorder Examination34; thus, overestimation of binge
episodes cannot be excluded. Nevertheless, the
prevalence rate of in our study was comparable
to that found in the telephone survey of Kinzl
et al.35 (11 and 12.2%, respectively), whereas other
studies using face-to-face interview techniques
revealed lower prevalence rates of 0.9–8% in the
general population (for an overview, see Munsch
et al.8).
Clinical Implications
Our findings showed that number of previous
dieting attempts and presence of binge eating
episodes were associated with different reasons
for weight loss as assessed by the WLM-Q. One
reason for high drop out rates in current weight
loss programs might be the ‘‘one size fits all’’
clinical practice, in which obese individuals are
treated uniformly, independent of their subgroup
characteristics and their reasons for weight loss.
It thus might not only be a question of generating new treatment modalities for overweight and
obese individuals to increase treatment success
but also of tailoring existing treatment options to
individuals’ specific needs and of enhancing
motivation interventions. In doing so, adherence
rates and ultimately weight loss success might be
improved. Further research will have to confirm
this suggestion using randomized controlled
trials.
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